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Historical Perspective
Myasthenia gravis (MG) has a history that dates back over three centuries (Pascuzzi 1994). It was first described in 1672 by an Oxford clinician, Thomas Willis. The first thymectomy was performed by Ferdinard Sauerbruch in Zurich in 1911 and reported by Shumacher and Roth the following year. The patient was a 21-year-old woma...
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Citations
... The appearance of the term "thoracoscopie " dates back to as early as 1800s (Hoksch et al., 2002). Earliest documented use of a modied cystoscope to observe the thoracic cavity is attributed to Swedish physician Jacobaeus (Ng & Yim, 2008). Thoracoscopy in those days is considered to be performed with whatever faint light available. ...
... (Chan et al., 2007) .VATS is considered a better alternative to thoracotomy in assessment of subjective criteria of physical functions, pain , breathing difculty, although results may vary depending on day or time of post op assessment. (Ng & Yim, 2008) More often, patients with empyema thoracis are the ones referred to surgery department from respiratory department for surgical intervention in our tertiary care hospital. With this background present study is conducted to study the utility of VATS in few commonly encountered respiratory diseases in our tertiary care set up. ...
... (21%) study subjects underwent VATS for empyema (TB/ Parapneumonic) in present study. Samir Johna et al , reported VATS use for empyema in (21%) (Johna et al., 1997) Anthony P. C. Yim et al. reported (6.5%) for empyema (Ng & Yim, 2008). Whereas Rene Jancovici et al reported pneumothorax as major indiaction (42.5%) of study population (Jancovici et al., 1996). ...
Background: VATS has diverse application from diagnostic usage to therapeutic measures. Hence the present study was undertaken to study the utility of VATS in respiratory diseases in our tertiary care centre. Methods: A total of 30 patients underwent VATS. Demographic data and peri operative details were noted. Surgical outcome, conversion rate, length of hospital stay and complications were noted. Results: Majority of study subject's age range was from (20 -40) years. (63.3%). The male: female ratio was 1.5:1. Commonest indication was Empyema( TB/Parapneumonic ) (53.33%) followed by Post thoracis trauma (6.6%) , Cystic Disease /Bulle/Pneumothorax (6.6%), Fungal Aspergilloma (6.6% ), Pleural Biopsy (6.6%) , Pulmonary Hydatid Disease (6.6%), Lung Abscess ( 6.6%) , Ca Oesophagus for VATS Esophagectomy (3.3%) and Suspicious malignant Pleural Effusion ( 3.3%).Therapeutic indication was (76.6%), diagnostic indications were (6.6%) and both were (16.6%). Diagnostic accuracy was (93.3 %). Conversion rate was (20 %). Complications were seen in (30%). Average hospital was found to be 12.59 +/- 5. 41 days (7-34 day) and chest tube drainage was 8.7 days +/- 3.0 days. Conclusions: VATS enables diagnostic accuracy for better therapeutic management. Our experience suggests that VATS is an alternative means of treatment and an excellent initial approach to various respiratory diseases.
Intrathorakale Erkrankungen mit chirurgischer Relevanz sind im Kindesalter insgesamt nicht ungewöhnlich und haben ein vielfältiges
Spektrum. Jede einzelne in diesem Kapitel beschriebene Entität für sich betrachtet kommt dabei eher selten vor. In diesem
Kapitel wird nach einer kurzen Übersicht über die Embryologie der gesunden Lunge auf die wesentlichen kongenitalen Fehlbildungen
und erworbenen Erkrankungen der Lunge, der Pleurahöhle und des Mediastinums eingegangen. Die Mehrzahl der chirurgisch relevanten
Erkrankungen und Fehlbildungen kommen fast ausschlleßlich im Säuglings- und Kindesalter vor. Diese Tatsache sowie die vom
Erwachsenen unterschiedllchen physiologischen Verhältnisse, die kleinen anatomischen Verhältnisse und die große Verletzlichkeit
der Gewebestrukturen bedingen, dass die operative Versorgung der geschilderten Erkrankung unbedingt von Chirurgen durchgeführt
werden sollte, die Erfahrung mit kindlicher Thoraxchirurgie besitzen.
To perform a complete cost analysis comparing robot assisted radical cystectomy (RARC) versus open radical cystectomy (ORC).
After institutional review board approval for data collection, we prospectively recorded perioperative outcomes and costs, such as hospital stay, transfusion rate, readmission rate, and medications for consecutive patients undergoing RARC or ORC. Using actual cost data, we developed a cost decision tree model to determine typical perioperative costs for both RARC and ORC. Multivariate sensitivity analysis was performed to elucidate which variables had the greatest impact on overall cost. Breakeven points with ORC were calculated using our model to better evaluate variable influence. In addition to the above modeled analysis, actual patient costs, including complications 30 days from surgery, were also compared for each procedure.
Our model analysis showed that operative time and length of stay had the greatest impact on perioperative costs. Robotic cystectomy became more expensive than open cystectomy at the following break-even points: operating room (OR) time greater than 361 minutes, length of stay greater than 6.6 days, or robotic OR supply cost exceeding $5853. RARC was 16% more expensive when only comparing direct operative costs. Interestingly, actual total patient costs revealed a 38% cost advantage favoring RARC due to increased hospitalization costs for ORC in our cohort.
RARC can provide a cost-effective alternative to ORC with operative time and length of stay being the most critical cost determinants. Higher complication rates with ORC make total actual costs much higher than RARC.
